To validate a newly developed multiple symptom self-assessment tool in nursing homes.
Thirty prevalent symptoms identified in the literature were classified by a 2-round Delphi procedure to a top 10 of the most relevant, burdensome symptoms. Because no existing symptom scale fully covered this top 10, we developed a new scale, consisting of a horizontal numerical scale for the top 10 symptoms, with the possibility to add and rate 3 other symptoms. This scale was validated.
Setting and participants
Hundred seventy-four participants, mean age 85 (±5.94) years, were recruited from 7 nursing homes (86%) and 3 acute geriatric wards (14%).
To test the construct validity, participants with and without a palliative status were enrolled. Participants completed the Symptom Assessment to Improve Symptom Control for Institutionalized Elderly (SATISFIE) scale on day 0 and day 1 (intrarater reliability). Nurses completed the scale on day 0 (inter-rater reliability). Descriptive statistics described the characteristics of the study population and symptom scores. Differences in symptom scores between palliative and nonpalliative participants were analyzed with the Mann-Whitney U test. Intrarater and inter-rater reliability were calculated by means of an intraclass correlation coefficient. Factor analysis searched for possible symptom clusters. Feasibility was evaluated by measuring the assessment time and by providing a questionnaire for the nurses.
In the nonpalliative group (n = 130), the highest self-rated median scores were pain on day 1 [median 3, interquartile range (IQR) 0–5] and pain on day 2. In the palliative group (n = 44), the highest median self-rated scores were fatigue on day 1 [median 5 (IQR 0–6)], lack of energy on day 1 and 2 [both median 5 (IQR 0–8)]; and depressed feeling on day 2 [median 3 (IQR 0–5)]. Nurse assessments median scores were the highest for depressed feeling [median 5 (IQR 1–7)], fatigue [median 4.5 (IQR 0–6.5)], and lack of energy, [median 3 (IQR 0–6)] in the palliative group. In the nonpalliative group, none of the median scores was 3 or more. Intraclass correlation coefficients for intrarater reliability varied between 0.65 and 0.89 and for inter-rater reliability (patients-nurses) between 0.18 and 0.63. Mean assessment time for nurses was 2.0 minutes [standard deviation (SD) = 1.01]. For participants, it decreased from 10.5 minutes (SD = 5.41) at the first assessment to 7.5 minutes (SD = 3.72) at the second assessment. Nurses determined the SATISFIE instrument to be useful, applicable in daily practice, and sufficiently comprehensible for the patients.
The SATISFIE scale is a valid and feasible instrument for regular, multiple symptom assessment in institutionalized older persons.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Ageing characteristics the demographic perspectives of the European societies.Eurostat. 2008; 72: 1
- Macroeconomic implications of population ageing and selected policy responses.Lancet. 2015; 385: 649-657
- Better Palliative Care for older people.WHO, Geneva, Switzerland2004
- Policies and managerial guidelines.2nd edition. WHO, Geneva2002
- Shorter symptom assessment instruments: The condensed Memorial Symptom Assessment Scale (CMSAS).Cancer Invest. 2004; 22: 526-536
- The Edmonton Symptom Assessment System: A 15-year retrospective review of validation studies (1991–2006).Palliat Med. 2008; 22: 111-122
- Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients.J Gerontol A Biol Sci Med Sci. 2005; 60: 524-529
- Pain reports and pain medication treatment in nursing home residents with and without dementia.Geriatr Gerontol Int. 2014; 14: 541-548
- Pain assessment using self-reported, nurse-reported, and observational pain assessment tools among older individuals with cognitive impairment.Pain Manage Nurs. 2015; 16: 595-601
- Measuring symptom distress among frail elders capable of providing self-reports.Nurs Health Sci. 2005; 7: 184-191
- Improving dementia care in nursing homes: Experiences with a palliative care symptom-assessment tool (MIDOS).Int J Palliat Nurs. 2014; 20: 187-192
- Schmerz. 2010; 24: 596-604
- A review of the reliability and validity of the Edmonton Symptom Assessment System.Curr Oncol. 2009; 16: 55
- Generic and disease-specific measures of quality of life in patients with mild Alzheimer's disease.Dement Geriatr Cogn Disord. 2010; 30: 327-333
- Dying in a nursing home: Treatable symptom burden and its link to modifiable features of work context.J Am Med Dir Assoc. 2015; 16: 515-520
- From admission to death: Prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia.J Am Med Dir Assoc. 2015; 16: 475-481
- Type and course of symptoms demonstrated in the terminal and dying phases by people with dementia in nursing homes.Z Gerontol Geriatr. 2015; 48: 176-183
- Pain assessment in elderly with behavioral and psychological symptoms of dementia.J Alzheimers Dis. 2016; 50: 1217-1225
- Pain assessment strategies in older patients.J Pain. 2011; 12: S3-S13
- Symptoms and treatment when death is expected in dementia patients in long-term care facilities.BMC Geriatr. 2014; 14: 99
- Improving hospice outcomes through systematic assessment: A clinical trial.Cancer Nurs. 2011; 34: 89-97
- Self- and proxy-report for the assessment of pain in patients with and without cognitive impairment: Experiences gained in a geriatric hospital.Z Gerontol Geriatr. 2013; 46: 214-221
- Meaning-in-life in nursing-home patients: A correlate with physical and emotional symptoms.J Clin Nurs. 2014; 23: 1030-1043
Published online: October 14, 2017
The PhD trajectory of Marc Tanghe is funded by the “PACE” project of the EU (Framework Program 7 Grant Agreement 603111).
The authors declare no conflicts of interest.
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.